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Primary care needs safer staffing too

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Media coverage has ignored primary care Media coverage has ignored primary care safe staffing needs

There has been a huge amount of coverage in the media regarding safe staffing in the last week. Much of it has related to hospital environments where there is a defined number of beds and where, in many cases, the flow of patients is determined by planned admissions and surgical interventions.

In the community and in primary care, nurses work in a very different environment, managing caseloads that are not restricted by the size of the building and the number of beds. District nurses find it challenging to say that their caseload is ‘full’ – they continue to absorb new patients, extending their day to accommodate the need with unpaid overtime. Similarly, the work of the nurse in general practice is determined by the allocated sessions for clinics and the number of appointments available within that time. As demand rises, many nurses are extending their days to accommodate more patients and manage the associated administration.

While the main focus of the district and practice nursing reports by the QNI was not solely on staffing issues, workforce pressure was a major theme in both and one about which we should be truly alarmed. Both pieces of work provide strong evidence of the need for common and agreed guidance relating to demand, capacity and prediction of workforce need – what the QNI have referred to as determining ‘safe caseloads’.

Such guidance needs to encompass all the variables to be taken into consideration when deciding the profile of the workforce to meet the needs of the individuals, families and carers in any one locality, at any one point in time. The guidance needs to be sufficiently nuanced to account for local variables – for example, the provision of third sector hospice and home care services will impact on the demand for the district nursing service. And it needs to be flexible and responsive in accommodating change, such as the development of new housing or residential care homes in the area, which may increase the demand for primary and community services.

The QNI is therefore delighted that in 2016 there will be a focus on sustainable safer staffing in primary care and community services, which will be supported by the National Quality Board. This work will provide an opportunity to gather the evidence from a wide range of experts in the field and agree a consensus view on safe caseloads, which can be used to create comprehensive guidance for providers and commissioners of the services.

Crystal Oldman, chief executive, Queen’s Nursing Institute

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